FIM cards -2

PTAS 103

• Functional Independence Measure (FIM)

The Use of the FIM

• Functional Independence Measure (FIM) serves multiple functions:

  • Tests and Measures

  • Data collection

  • Provides an objective measure

  • Applicable across multiple services

  • Commonly utilized in subacute, skilled nursing, and rehabilitation settings

  • Establishes assistance levels to reflect patient status, progress, or regression in various healthcare contexts

Areas Tested

• The FIM evaluates specific skills, particularly in Physical Therapy (PT):

  • Gait

  • Stair navigation

  • Bed mobility

  • Wheelchair propulsion

• Scoring is conducted at:

  • Initial status (admission, evaluation, team meeting)

  • Expected outcomes from treatment (treatment goals during evaluation)

  • Discharge

• Collected data is utilized to demonstrate treatment effectiveness and facility performance

The Levels of Assistance

• Levels assigned based on:

  • Proportion of task work performed by the patient

  • Equipment required for the task

  • Number of individuals assisting the patient

  • Patient's potential capability of performing the task independently

The Scale

• Utilizes a system similar to manual muscle testing

  • Specific terminology and a numerical system are employed

  • No decimal points or half numbers are used

  • One level only must be chosen

  • Always err on the side of caution to ensure patient safety

Concerns

• The FIM is a widely recognized terminology among medical professionals

• Levels assigned reflect patient effort:

  • Staff consistency and agreement on scores are crucial for objectivity

  • Incorrect scoring can lead to safety risks for both the patient and healthcare providers

Understanding the Basic Scale

• Higher scores indicate:

  • Increased independence in task completion

  • Less reliance on assistance from others

  • Decreased need for specialized equipment

  • Timely completion of tasks

FIM Scale Explanation

• 7 = Independent (I)

  • Patient completes 100% of the task without assistance or equipment and within a standard time

• 6 = Modified Independent (Mod (I))

  • Patient completes 100% alone but may require equipment or more time

• 5 = Supervision (S) / Standby Assistance (SB(A))

  • One person needed for supervision without physical contact

• 4 = Minimum Assistance (Min (A))

  • One person assists, touching the patient, 75% task completion

• 3 = Moderate Assistance (Mod (A))

  • One person assists, touching the patient, 50-74% completion

• 2 = Maximum Assistance (Max (A))

  • One person assists, touching the patient, 25-49% completion

• 1 = Dependent (D)

  • More than one person required, touching the patient, less than 25% task completion

• 0 = Total Assistance

  • Patient's condition renders them unable to complete the task even with assistance

Detailed Descriptions of Levels

• 7 – Independent: Complete independence in task execution without any assistance or safety concerns.

• 6 – Modified Independent: Full completion but may require equipment or extra time.

• 5 – Supervision: Requires oversight without direct contact, may need setup assistance.

• 4 – Minimum Assistance: Patient needs physical touch and completes at least 75% of the task.

• 3 – Moderate Assistance: Patient requires physical touch and completes 50-74% of the task.

• 2 – Maximum Assistance: Requires touch for 25-49% task completion.

• 1 – Dependent: Less than 25% task completion requiring environmental support and touch from multiple caregivers.

• 0 – Total Assistance: Condition prevents task performance; not judged on this activity.

Questions to Assess FIM Level

1. Does the patient require an additional person for this task?

   • Yes: Review further;

   • No: Continue asking questions.

2. Does the patient need equipment?

   • Yes: Assign 6 (Mod (I));

   • No: Continue.

3. Does the patient complete the task within time expectations?

   • Yes: Assign 7 (I);

   • No: Assign 6 (Mod (I)).

4. How many people assist?

   • One: Review further;

   • More than one: Assign 1 (D).

5. Is PTA/PT touching the patient?

   • No: Assign 5 (S);

   • Yes: Continue.

6. What percentage of the task is completed by the patient?

   • 75% or more: Assign 4 (Min A);

   • 50% to <75%: Assign 3 (Mod A);

   • 25% to <50%: Assign 2 (Max A);

   • <25%: Assign 1 (D);

   • If not appropriate, assign 0.

Example Questions for FIM Level Assignment

• Scenario 1: Patient getting in/out of a car with spouse present.

  • Required additional assistance, score = 5 (Supervision/SB(A)).

• Scenario 2: Patient ambulates with walker but requires assistance.

  • Score = 2 (Max (A)).

• Scenario 3: Patient sliding board transfer to mat table.

  • Score = 6 (Mod (I)).

• Scenario 4: Patient can ambulate with crutches with setup help.

  • Score = 5 (SB(A)).

• Scenario 5: Patient transferring with gait belt assistance, 50-75% completion

  • Score = 3 (Mod (A)).

Additional Assistance Level Designation

• FIM dictates specific assignment criteria. If not aligning with FIM, alternative terms may be utilized.

Other Assistance Terms

• Contact Guard Assistance (CG(A)): Patient performs at least 90% of the task but requires touching for safety; the "touching" is a precautionary measure.

Non-FIM Assistance Designation

• More than one person complicates FIM assessment; progression is unclear unless reduced to a single assistant.

Combined Assistance Levels

• Representing wide variability in patient abilities, showcasing safety needs for practitioners; always select one number for FIM to reflect safety.